The third issue of the medical education marathon is dedicated to the pilot project “Advanced nurse practitioner in the primary health care”


When talking about the effectiveness of the health care system, it is important to mention the availability and quality of health care. That is why we have dedicated this issue of the Medical Education Marathon to those health workers who are often underestimated and ignored by the community. Today, providing quality medical care is impossible without the help of a nurse. When discussing their role, it is essential to understand and figure out how to raise the prestige of this profession in the community. Can a nurse perform highly qualified work? Does the employer want to give wider powers? Is the patient ready?

Therefore, during the live broadcast, we talked about:

  • improving the accessibility of services for patients,
  • the first achievements of the project “Advanced nurse practitioner,”
  • based on our own experience, we talked about how to increase the efficiency of the health system resources usage by strengthening the nurse’s role.

According to a study on the distribution of team roles in primary health care, conducted by the Ukrainian-Swiss project “Development of Medical Education,” expanding the nurse’s role is possible. There is readiness; the legislation does not prevent implementing such an expansion. So, we need to work on the education of nurses. In this study, we heard nurses, doctors, and managers.

“We found that almost 40% of nurses and almost 2/3 of managers say that some functions currently performed by a doctor can be delegated to a nurse,” said Daryna Bogdan, capacity building and M&E coordinator, the Ukraine-Swiss project “Development of medical education.” In addition, the study identified three models of how nurses and primary care physicians work. “We have seen that today 90% of nurses and doctors have a joint reception; they sit in the same office, work with the patient and share responsibilities. We called this model ‘traditional’ in the study,” added Daryna. We also found a model of ‘doctor’s substitution,’ which is relevant for rural areas, where a nurse takes over his powers without a doctor. The last model is ‘doctor’s solo practice.’ It is more common in private institutions and is based on economic efficiency and convenience in institution management. “Managers of these institutions say that in the long run, it will not be cost-effective when the workload of the doctor increases; it will be necessary to introduce the role of a nurse and give her part of the functionality,” commented Bogdan.

An advanced nurse practitioner is world practice. In many countries, this model is successful and efficient. “Let’s say in England, according to one poll, the nursing profession is among those who are trusted the most. There, the nurse conducts the initial reception of patients, certain manipulations, diagnostic tests, vaccinations,” said Ivan Didyk, medical director of the medical center “Vidnovlennia,” consultant of the Ukrainian-Swiss project on nursing and implementation of the project “Advanced nurse practitioner.”

In Ukraine, nurses are often more ambitious, wanting to do more exciting work than filling out medical records. Expanding the powers of the nurse is valuable to the PHC team. “The team could do more work more efficiently. We need to remember that the main consumer of services is the patient. For him, the greater involvement of the nurse in the medical process indicates an increase in his access to medical services,” explained Matvii Khrenov, co-founder of the Ukrainian Health Center (UHC).

The first results of implementing the project “Advanced nurse practitioner at the PHC” have a positive response. Most importantly, this response is from nurses. “Primary care is provided not only by a family doctor. It is a teamwork of a doctor and a nurse. In today’s world, the role of a family doctor has changed. The nurse needs to develop herself, and her role needs to expand,” said Natalia Ruzhnytska, deputy director, PHC Center of Chortkiv City Council.

Nurses want changes; they need new knowledge and are interested in professional development. “Nurses have already started an independent reception at our institution. They invite patients by telephone from the dynamic observation group, conduct examinations and counseling, and provide consultations accordingly. In counseling, they are interested in asking more questions and paying attention to the patient. Our nurses learned not only clinical skills but also communication skills. They use them skillfully, patients are satisfied”, says Valentyna Duka, crisis management manager, PHC Center Yuvileynyi for Rivne City Council.

We are happy with such results and will keep you informed about the deployment of the pilot project! You can view other issues of the medical education marathon at this link →

Медичним сестрам хочеться змін, вони потребують нових знань і зацікавлені у професійному розвитку. «У нашому закладі медсестри вже розпочали самостійний прийом. Вони самі запрошують пацієнтів у телефонному режимі з динамічної групи спостереження, роблять обстеження, опитування і згідно з цим надають консультації. Надаючи консультації вони зацікавлені в тому аби більше розпитати й приділити уваги пацієнту. Наші медичні сестри навчалися не тільки клінічним навички, а й комунікаційним. Вони їх вправно застосовують, пацієнти задоволені», говорить Валентина Дука, менеджерка з антикризового управління, ЦПМСД «Ювілейний» Рівненської міської ради. 

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